Provider Demographics
NPI:1922101724
Name:THE COMMONWEALTH OF MASSACHUSETTS
Entity Type:Organization
Organization Name:THE COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:TAUNTON STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-977-3121
Mailing Address - Street 1:PO BOX 4007
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-0997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 HODGES AVE
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3034
Practice Address - Country:US
Practice Address - Phone:508-977-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-07
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110000084HMedicaid
MA110000084HMedicaid